I used to daydream that my first patient as a medical student would be a happy, reasonably healthy elderly woman. The patient would tell me I reminded her of her grandson. I would let her show me pictures of her family, kept in her purse. When I eventually discharged her, she would take my hands in hers and smile. “What an excellent doctor you’ll make one day,” she would say.
Idealism blooms in the warmth of imagination; reality is usually less hospitable.
My real first patient was a cachectic and homeless woman with HIV who had been off of her antiviral medications for the past three years. She was in an altered mental status after using crack-cocaine. Her multiple, severe infections probably explained why she’d been, in her own words, “defecating for the past three days.” She didn’t use the word “defecating,” though.
The resident and I arrived outside her door, donning gloves, gowns and masks. I put the mask on incorrectly, so my glasses fogged up with each breath. I felt like an astronaut preparing for a spacewalk only without any training. We entered the room, walked to her bedside and observed her. I was no healer. And she was no patient of whom I’d ever dreamed.
She was E.T. with her dark, wrinkled skin stretched tautly around her over-sized head, her eyes barely open and her body aching for home. And we were the scientists staring down at her in our ridiculous hazmat suits full of wonder and awe. Only I did not feel wonder, nor awe. I felt dumb, uselessly staring at her through my foggy glasses. I felt ashamed for comparing my first patient to a fictional and notoriously unattractive alien.
And yet …
I imagined reaching my hand out to hers as Elliott and E.T do in the movie. Our hands would touch finger pad to finger pad, affirming to her that she was here with me, really, and to myself that I was here with her, too. I imagined our fingers glowing with warmth as they met, infections evaporating from her body and fear from mine.
I imagined her getting up and leaving the hospital. I would watch from the hospital window as she got onto the bike I’d left for her in the parking lot, rode into the clear, starry sky and then further away into the cosmos.